Quality Control Reviewer III

Job Title

Responsibilities :

• Greet and assist retirees over the phone and via email; review and validate member demographics against database to measure system accuracy.
• Assist 1199SEIU retired members with inquiries regarding Retiree Health and Pension Benefit eligibility and payment status.
• Review and verify submitted Pension applications and forms ensuring all required documentation is provided and complete.
• Explain application process and assist members with enrollment for the 1199SEIU Medicare Advantage Plan or Medicare Part D; assist members with Aetna MAPD enrollment.
• Schedule interviews with prospective pensioners; update members with status of pension applications.
• Communicate with members, via telephone and / or email regarding claims and other benefit related inquiries; provide support to Telephone Representatives as needed.
• Troubleshoot problems, assist members / retirees in resolving difficult and complex issues related to pension, claims, retiree benefits and payments, answer questions regarding policies, retiree programs and service.
• Partner with various departments (i.e. : Eligibility, Medical Claims and Pension) to resolve member inquiries.
• Compose verification letters, generate duplicate 1099R tax forms, explanation of benefits and health identification cards at members' request; request letters of Creditable Coverage as needed.
• Access web-based applications relevant to inquiries (i.e. : V3, QNXT, Superscreen, BeneFaqs, Medco, iObserver, DocFind, etc.).
• Perform additional duties and projects as assigned by management.

Qualifications :